Model for End-Stage Liver Disease (Combined MELD)

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Model for End-Stage Liver Disease (Combined MELD)

Predicts 90-day mortality in patients ≥12 years with advanced liver disease to guide transplant prioritization

All tools /

Model for End-Stage Liver Disease (Combined MELD)

Predicts 90-day mortality in patients ≥12 years with advanced liver disease to guide transplant prioritization

MELD Version

MELD Score (Original, Pre-2016)MELD Na (prior UNOS/OPTN version)MELD 3.0 (currently recommended by OPTN)

Serum Creatinine

Serum Bilirubin

INR

Dialysis at least twice in the past week

Or 24 hours of CVVHD

YesNo

MELD Score (Original, Pre-2016): —

3-month mortality: —

0/4 answered · tap options to update

Instructions

The Combined MELD Score is used to estimate disease severity and predict short-term survival in patients with advanced liver disease. To calculate, collect values for serum bilirubin, INR, serum creatinine, and serum sodium. Apply the original MELD formula and incorporate sodium adjustment to improve accuracy in prognosis. Ensure laboratory values are current, and apply caps or limits where required. The score is bounded between 6 and 40. This tool supports clinical decision-making for transplant listing, prioritization, and overall prognosis assessment.

Overview

When to use

Why use

Evidences

Interpretation

Combined MELD Score	Estimated 90-Day Mortality
≤ 9	~1.9%
10 – 19	~6.0%
20 – 29	~19.6%
30 – 39	~52.6%
≥ 40	~71.3%

MELD was originally derived at Mayo Clinic to predict short‑term mortality after TIPS using bilirubin, INR, and creatinine; it was quickly validated to predict 3‑month mortality across broader cirrhosis cohorts and adopted by UNOS in Feb 2002 to prioritize liver transplant allocation based on “sickest first” principles.
https://pmc.ncbi.nlm.nih.gov/articles/PMC3940492/

Comparative studies confirm MELD’s strong discrimination for waitlist mortality and its utility across settings; later enhancements (MELD‑Na, MELD 3.0) further improved calibration by incorporating hyponatremia and sex/albumin adjustments, but the original “combined MELD” remains foundational and widely reported
https://pmc.ncbi.nlm.nih.gov/articles/PMC4904690/

Overview

When to use

Why use

Evidences

The Model for End-Stage Liver Disease (MELD) is a scoring system that predicts short-term mortality in patients with advanced liver disease. Originally developed for patients undergoing transjugular intrahepatic portosystemic shunt (TIPS), it is now the global standard for organ allocation in liver transplantation.

The Combined MELD, often referred to as MELD-Na, incorporates serum sodium alongside bilirubin, creatinine, and INR, improving predictive accuracy because hyponatremia is strongly associated with higher mortality.

This tool uses objective, routinely available laboratory values. Serum creatinine reflects kidney function, bilirubin measures liver clearance, INR evaluates coagulopathy, and sodium represents fluid balance and complications like ascites. The inclusion of sodium was validated by large multicenter studies and adopted by UNOS/OPTN to improve fairness and accuracy in organ distribution.